Methods and apparatus for stabilizing bone

ABSTRACT

In some embodiments, a method comprises disposing a portion of a flexible fastening band into contact with a first bone portion and into contact with a second bone portion. The portion of the flexible fastening band having a substantially uniform shape configured to substantially compliment a shape of the first bone portion and a shape of the second bone portion. The method further includes inserting the portion of the flexible fastening band into a fastener and advancing the portion of the flexible fastening band through the fastener until the first bone portion and the and the second bone portion are stabilized.

CROSS REFERENCE AND RELATED APPLICATIONS

This application is a continuation application of U.S. patentapplication Ser. No. 13/033,791 entitled “Methods And Apparatus ForStabilizing Bone,” filed Feb. 24, 2011, which is incorporated herein byreference in its entirety.

BACKGROUND

Some embodiments described herein relate generally to methods andapparatus for stabilizing bone, for example, stabilizing vertebrae bysecuring the articular processes of the vertebrae.

Traumatic, inflammatory, and degenerative disorders of the spine canlead to severe pain and loss of mobility. One source of back and spinepain is related to degeneration of the facets of the spine or facetarthritis. Bony contact or grinding of degenerated facet joint surfacescan play a role in some pain syndromes. While many technologicaladvances have focused on the intervertebral disc and artificialreplacement or repair of the intervertebral disc, little advancement infacet repair has been made. Facet joint and disc degeneration frequentlyoccur together. Thus, a need exists to address the clinical concernsraised by degenerative facet joints.

The current standard of care to address the degenerative problems withthe facet joints is to fuse the two adjacent vertebrae. By performingthis surgical procedure, the relative motion between the two adjacentvertebrae is stopped, thus stopping motion of the facets and anypotential pain generated as a result thereof. Procedures to fuse twoadjacent vertebrae often involve fixation and/or stabilization of thetwo adjacent vertebrae until the two adjacent vertebrae fuse.

Injuries and/or surgical procedure on and/or effecting other bones canalso result in the desire to fixate and/or stabilize a bone until thebone, or bone portions, can fuse, for example, to stabilize a sternumafter heart surgery, to stabilize a rib after a break, etc. Currentprocedures to fixate and/or stabilize adjacent vertebrae and/or otherbones can be slow and/or complex.

Accordingly, a need exists for an apparatus and a procedure to quicklyand/or easily stabilize and/or fixate a bone.

SUMMARY

In some embodiments, a method comprises forming a lumen in a first boneportion and forming a lumen in a second bone portion. The method furtherincludes inserting a portion of a flexible fastening band through thelumen in the first bone portion and through the lumen in the second boneportion, and inserting the portion of the flexible fastening band into afastening mechanism monolithically formed with the flexible fasteningband. The method further includes advancing the portion of the flexiblefastening band through the fastening mechanism until the first boneportion and the and the second bone portion are stabilized.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a lateral elevational view of a portion of the vertebralcolumn.

FIG. 2A is a schematic superior view of an isolated thoracic vertebra.

FIG. 2B are schematic side view of an isolated thoracic vertebra.

FIG. 3A is a schematic posterior elevational view of a portion of thevertebral column.

FIG. 3B is a posterior-oblique elevational view of a portion of thevertebral column.

FIG. 4A is a schematic side view of a facet joint in the cervicalvertebrae.

FIG. 4B is a schematic superior view of a facet joint in the cervicalvertebrae.

FIG. 5A is a schematic side view of a facet joint in the thoracicvertebrae.

FIG. 5B is a schematic superior view of a facet joint in the thoracicvertebrae.

FIG. 6A is a schematic side view of a facet joint in the lumbarvertebrae.

FIG. 6B is a schematic superior view of a facet joint in the lumbarvertebrae.

FIG. 7 is a block diagram of a flexible fastening band according to anembodiment.

FIGS. 8-10 are posterior perspective views of a portion of the vertebralcolumn depicting a method of stabilizing a vertebra using a flexiblefastening band according to an embodiment.

FIG. 11 is a flow chart illustrating a method of using the flexiblefastening band depicted FIGS. 8-10.

FIG. 12 is a perspective view of a flexible fastening band according toan embodiment.

FIG. 13 is a perspective view of a portion of the flexible fasteningband depicted in FIG. 12.

FIG. 14 is a posterior perspective view of a portion of the vertebralcolumn depicting a stabilized vertebra including the flexible fasteningband of FIG. 12 according to an embodiment.

FIG. 15 is a perspective view of a spacer according to an embodiment.

FIG. 16 is a posterior perspective view of a portion of the vertebralcolumn depicting a stabilized vertebra including a flexible fasteningband and the spacer of FIG. 15 according to an embodiment.

FIG. 17 is a flow chart illustrating a method of using a flexiblefastening band and the spacer of FIG. 15.

FIG. 18 is a side view of a flexible fastening band according to anembodiment.

FIG. 19 is a top view the flexible fastening band depicted in FIG. 18.

FIG. 20 is a side view of a flexible fastening band according to anembodiment.

FIG. 21 is a perspective view of a flexible fastening band according toan embodiment.

FIG. 22 is a cross-sectional side view of the flexible fastening banddepicted in FIG. 21.

FIG. 23 is a cross-sectional view taken along line XXIII of the flexiblefastening band depicted in FIG. 21.

FIG. 24 is a cross-sectional top view of the flexible fastening banddepicted in FIG. 21 in a first configuration.

FIG. 25 is a cross-sectional top view of the flexible fastening banddepicted in FIG. 21 in a second configuration.

FIG. 26 is an exploded view of a flexible fastening band according to anembodiment.

FIG. 27 is a perspective view of the flexible fastening band depicted inFIG. 26.

FIG. 28 is a cross-sectional view of the flexible fastening banddepicted in FIG. 27.

FIG. 29 is a posterior perspective view of a portion of the vertebralcolumn depicting a stabilized vertebra including two flexible fasteningbands of FIG. 26.

FIG. 30 is a posterior perspective view of a portion of the vertebralcolumn depicting a stabilized vertebra including two flexible fasteningbands and two spacers according to an embodiment.

DETAILED DESCRIPTION

In some embodiments, a method comprises disposing a portion of aflexible fastening band into contact with a first bone portion and intocontact with a second bone portion. The portion of the flexiblefastening band having a substantially uniform shape configured tosubstantially compliment a shape of the first bone portion and a shapeof the second bone portion. The method further includes inserting theportion of the flexible fastening band into a fastener and advancing theportion of the flexible fastening band through the fastener until thefirst bone portion and the and the second bone portion are stabilized.

In some embodiments, an apparatus includes a flexible elongate bodyincluding a proximal end portion, a first portion, a second portion, areinforcement portion, and a distal end portion. The distal end portionof the flexible elongate body includes a fastener configured to acceptthe proximal end portion and the first portion. The second portionincludes a first material, and the reinforcement portion includes asecond material, different from the first material and stronger than thefirst material. The reinforcement piece is disposed within at least aportion of the second portion.

In some embodiments, an apparatus comprises a flexible elongate bodyincluding a proximal end portion, a first portion, a second portionmutually exclusive from and distal to the first portion, and a distalend portion. The apparatus further comprises a fastener configured toaccept the proximal end portion and the first portion. The first portionof the flexible elongate body having a length and a substantiallyuniform first shape and the second portion of the flexible elongate bodyhaving a length and a substantially uniform second shape, different fromthe first shape, that is configured to substantially compliment a shapeof first bone portion and a shape of a second bone portion. The fastenerconfigured to receive the first portion of the flexible elongate bodywhen the second portion of the flexible elongate body is disposed incontact with the first bone portion and in contact with the second boneportion.

As used in this specification, the singular forms “a,” “an” and “the”include plural referents unless the context clearly dictates otherwise.Thus, for example, the term “a ratchet” is intended to mean a singleratchet or a combination of ratchets. As used in this specification, asubstance can include any biologic and/or chemical substance, including,but not limited to, medicine, adhesives, etc. While exemplary referencesare made with respect to vertebra, in some embodiments another bone canbe involved. While specific reference may be made to a specific vertebraand/or subset and/or grouping of vertebrae, it is understood that anyvertebra and/or subset and/or grouping, or combination of vertebrae canbe used.

As shown in FIG. 1, the vertebral column 2 comprises a series ofalternating vertebrae 4 and fibrous discs 6 that provide axial supportand movement to the upper portions of the body. The vertebral column 2typically comprises thirty-three vertebrae 4, with seven cervical(C1-C7), twelve thoracic (T1-T12), five lumbar (L1-15), five fusedsacral (S1-S5) and four fused coccygeal vertebrae. FIGS. 2A and 2Bdepict a typical thoracic vertebra. Each vertebra includes an anteriorbody 8 with a posterior arch 10. The posterior arch 10 comprises twopedicles 12 and two laminae 14 that join posteriorly to form a spinousprocess 16. Projecting from each side of the posterior arch 10 is atransverse 18, superior 20 and inferior articular process 22. The facets24, 26 of the superior 20 and inferior articular processes 22 form facetjoints 28 with the articular processes of the adjacent vertebrae (seeFIGS. 3A and 3B). The facet joints are true synovial joints withcartilaginous surfaces and a joint capsule.

The orientation of the facet joints vary, depending on the level of thevertebral column. In the C1 and C2 vertebrae, for example the facetjoints are parallel to the transverse plane. FIGS. 4A to 6B depictexamples of the orientations of the facet joints at different levels ofthe vertebral column. In the C3 to C7 vertebrae examples shown in FIGS.4A and 4B, the facets are oriented at a 45-degree angle to thetransverse plane 30 and parallel to the frontal plane 32, respectively.This orientation allows the facet joints of the cervical vertebrae toflex, extend, lateral flex and rotate. At a 45-degree angle in thetransverse plane 30, the facet joints of the cervical spine can guide,but do not limit, the movement of the cervical vertebrae. FIGS. 5A and5B depict examples of the thoracic vertebrae, where the facets areoriented at a 60-degree angle to the transverse plane 30 and a 20-degreeangle to the frontal plane 32, respectively. This orientation is capableof providing lateral flexion and rotation, but only limited flexion andextension. FIGS. 6A and 6B illustrate examples of the lumbar region,where the facet joints are oriented at 90-degree angles to thetransverse plane 30 and a 45-degree angle to the frontal plane 32,respectively. The lumbar vertebrae are capable of flexion, extension andlateral flexion, but little, if any, rotation because of the 90-degreeorientation of the facet joints in the transverse plane. The actualrange of motion along the vertebral column can vary considerably witheach individual vertebra.

In addition to guiding movement of the vertebrae, the facet joints alsocontribute to the load-bearing ability of the vertebral column. Onestudy by King et al. Mechanism of Spinal Injury Due to CaudocephaladAcceleration, Orthop. Clin. North Am., 6:19 1975, found facet jointload-bearing as high as 30% in some positions of the vertebral column.The facet joints may also play a role in resisting shear stressesbetween the vertebrae. Over time, these forces acting on the facetjoints can cause degeneration and arthritis.

In some embodiments described herein, a flexible fastening band can beused to stabilize and/or fixate a first vertebra to a second vertebra toreduce the pain, to reduce further degradation of a spine, or of aspecific vertebra of a spine, and/or until the first vertebra and thesecond vertebra have fused. FIG. 7 depicts a block diagram of a flexiblefastening band (“band”) 140. Band 140 includes a flexible elongate bodyincluding a proximal end portion 142, a first portion 144, a secondportion 146, and a distal end portion 148 that includes a fasteningmechanism 150 (alternatively referred to herein as a fastener). In someembodiments, band 140 can include a third portion (not shown in FIG. 7).In some embodiments, band 140 can include a spacer (not shown in FIG.7). In some embodiments, the fastening mechanism can be separate fromthe distal end portion (see, e.g., FIGS. 26-30). Band 140 can beconfigured to stabilize a first vertebra (not shown in FIG. 7) and/or asecond vertebra (not shown in FIG. 7). Specifically, band 140 can beconfigured to stabilize the first vertebra and/or second vertebra bysecuring an articular process of the first vertebra to an articularprocess of a second vertebra. More specifically, band 140 can beconfigured to stabilize the first vertebra and/or a second vertebra bysecuring an articular process of the first vertebra to an articularprocess of a second vertebra by securing a facet of the articularprocess of the first vertebra with a facet of the articular process ofthe second vertebra. In some embodiments, band 140 can be removed fromthe vertebra, e.g. by cutting, breaking, or otherwise releasing band140. In this manner, should a band fail, a replacement band can beinserted. Similarly, should the band be deemed ineffective for aparticular patient, the band can be removed and an alternate treatmentcan be chosen without incurring permanent fusion of the vertebra. Aswill be described in more detail herein, band 140 can be monolithicallyformed or separately formed. Band 140 can include any biocompatiblematerial, e.g., stainless steel, titanium, PEEK, nylon, etc.

Proximal end portion 142 is configured to pass through a lumen formedthrough a vertebra and a lumen formed through an adjacent vertebra, andto pass through fastening mechanism 150 of the distal end portion 148.In some embodiments, proximal end portion 142 can be shaped to increasethe ease of inserting proximal end portion 142 into fastening mechanism150, e.g., proximal end portion 142 can be tapered, rounded, and/orangled, etc, to reduce at least a portion of a cross-sectional area ofproximal end portion 142.

First portion 144 can extend for a length between proximal end portion142 and second portion 146, and can have a substantially uniform shape.The first portion 144 can have, for example, a substantially cuboidalshape, or a substantially cylindrical shape. In some embodiments, thelength of first portion 144 can be more than twice the length of secondportion 146. In some embodiments, the cross-sectional area of the firstportion 144 can be smaller than the cross-sectional area of the secondportion 146. In some embodiments, the cross-sectional area of firstportion 144 can be less than a cross-sectional area of a lumen definedby the fastening mechanism 150. First portion 144 can include a gearrack (not shown in FIG. 7) configured to engage a ratchet (not shown inFIG. 7) of the fastening mechanism 150. The gear rack can be configuredto allow first portion 144 to travel through fastening mechanism 150 inonly one direction. First portion 144 can be monolithically formed withsecond portion 146. In some other embodiments, the first portion can beseparately formed from the second portion. First portion 144 can beconfigured to be slidably disposed in a lumen of second portion 146.

Second portion 146 can have a length between first portion 144 anddistal end portion 148, and can include a substantially uniform shape.In embodiments including the third portion, second portion 146 can havea length between first portion 144 and the third portion. Second portion146 can have, for example, a substantially cuboidal shape or asubstantially cylindrical shape. First portion 144 and second portion146 can have the same or different shapes, e.g., first portion 144 andsecond portion 146 can both be substantially cuboidal (see, e.g., band240 in FIG. 8), first portion 144 and second portion 146 can both besubstantially cylindrical (see, e.g., band 840 in FIG. 18), firstportion 144 can be substantially cuboidal while second portion 146 canbe substantially cylindrical (see, e.g., band 440 in FIG. 12), or firstportion 144 can be substantially cylindrical while second portion 146can be substantially cuboidal (not shown). In some embodiments, thelength of second portion 146 can be less than half the length of firstportion 144. In some embodiments, the cross-sectional area of the secondportion 146 can be greater than the cross-sectional area of the firstportion 144. In some embodiments, the cross-sectional area of secondportion 146 can be greater than a cross-sectional area of a lumendefined by the fastening mechanism 150. In this manner, as a portion ofband 140 is advanced through fastening mechanism 150, thecross-sectional area of second portion 146 can prevent band 140 fromadvancing beyond the first portion 144. Second portion 146 can include agear rack (not shown in FIG. 7) configured to engage the ratchet of thefastening mechanism 150. The gear rack can be configured to allow secondportion 46 to travel through fastening mechanism 150 in only onedirection. Second portion 146 can be monolithically formed with firstportion 144. In some embodiments, the second portion can be separatelyformed from the first portion. Second portion 146 can define a lumenconfigured to slidably accept first portion 144.

Distal end portion 148 includes a fastening mechanism 150 configured toaccept at least a portion of proximal end portion 142, first portion144, and/or second portion 146. In some embodiments, distal end portion148, second portion 146, first portion 144, and proximal end portion 142can be monolithically formed. Fastening mechanism 150 includes a lumen(not shown in FIG. 7) configured to accept at least a portion ofproximal end portion 142, a portion of first portion 142, and/or aportion of second portion 146. In some embodiments, the cross-sectionalarea of the lumen of fastening mechanism 150 is smaller than thecross-sectional area of second portion 146. In this manner, secondportion 146 can be prevented from advancing through fastening mechanism150. In some embodiments, fastening mechanism can include a ratchet (notshown in FIG. 7) configured to engage the gear rack of the first portion144 and/or second portion 146. In this manner, the fastening mechanismcan allow first portion 144 and/or second portion 146 to advance throughfastening mechanism 150 in only one direction.

In some embodiments, at least one of distal end portion 148, secondportion 146, first portion 144, and proximal end portion 142 can beformed separately from the other(s) of distal end portion 148, secondportion 146, first portion 144, and proximal end portion 142. Saidanother way, and by way of example, distal end portion 148, firstportion 144, and proximal end portion 142 can be monolithically formedtogether, while second portion 146 can be separately formed. In thismanner, band 140 can include an initial second portion 146 configured tobe replaced and/or covered with a replacement second portion 146. By wayof a first example, initial second portion 146 can be monolithicallyformed with first portion 144 and replacement second portion 146 can beslidably disposed over initial second portion 146. By way of a secondexample, initial second portion 146 can be separately formed from firstportion 144, can be removed from band 140, and replacement secondportion 146 can be slidably disposed over first portion 144. By way of athird example, initial second portion 146 can be separately ormonolithically formed from first portion 144, and replacement secondportion 146 can be slidably disposed over first portion 144 and initialsecond portion 146. In some embodiments, initial second portion 146 andreplacement second portion 146 can have the same shape, e.g., initialsecond portion 146 can include a substantially cylindrical shape andreplacement second portion 146 can include a substantially cylindricalshape. In some embodiments, initial second portion 146 and replacementsecond portion 146 can have different shapes, e.g., initial secondportion 146 can include a substantially cuboidal shape and replacementsecond portion 146 can include a substantially cylindrical shape.

In some embodiments, the shape of first portion 144 and the shape ofsecond portion 146 can be determined based on the shape of an artificiallumen formed through a articular process of a vertebra. By way ofexample, if the shape of the artificial lumen is cuboidal, the shape ofthe of the first portion 144 and the shape of the second portion 146 canbe cuboidal to allow the first portion 144 and the second portion 146 toslidably advance through the artificial lumen. By way of a secondexample, if the shape of the artificial lumen is cylindrical, the shapeof the first portion 144 and the shape of the second portion 146 can beeither cuboidal or cylindrical. Continuing with the second example, theshape of the first portion 144 can be cuboidal to allow the firstportion 144 to advance easily through the artificial lumen, while theshape of the second portion 146 can be cylindrical to allow the secondportion 146 to fit more tightly within the artificial lumen as comparedto a cuboidal shape.

In some embodiments, the shape of the first portion 144 and the shape ofthe second portion 146 can be determined based on characteristics of thebone or bone portion against which the first portion 144 and the secondportion 146 may contact. By way of example, while first portion 144and/or second portion 146 can be substantially cuboidal, edges of thefirst portion 144 and/or the second portion 146 can be rounded,partially rounded, and/or otherwise shaped to compliment the shape of abone or bone portion, and/or to reduce digging or grinding into the boneor bone portion. In this manner, use of band 140 may cause little or nodamage to the bone or bone portions contacted by band 140.

In some embodiments, band 140 can include a third portion (not shown inFIG. 7). The third portion can have a length between second portion 146and distal end portion 150, and can have a substantially uniform shape.In some embodiments, the third portion can have, for example, asubstantially cuboidal shape or a substantially cylindrical shape. Insome embodiments, the length of the third portion can be less than halfthe length of first portion 144. The third portion can be monolithicallyformed with first portion 144 and/or the second portion 146. In someother embodiments, the first portion can be separately formed from thesecond portion and/or the first portion.

While each of first portion 144, second portion 146, and the thirdportion can be a substantially uniform shape, in some embodiments anyone of first portion 144, second portion 146, and the third portion caninclude a transition portion to transition band 140 from a firstsubstantially uniform shape to a second substantially uniform shape. Byway of example, in some embodiments, first portion 144 and the thirdportion can be substantially cuboidal and second portion 146 can besubstantially cylindrical. In this example, second portion 146 caninclude an angled, conical, or other shaped transition portion (see,e.g., second portion 446 in FIG. 13).

In some embodiments, the band can include a spacer (not shown). Thespacer can be similar to, and have similar features to the embodimentsof the prosthesis shown and described in U.S. patent application Ser.No. 12/859,009; filed Aug. 18, 2010, and titled “Vertebral Facet JointDrill and Method of Use” (referred to as “the '009 application”), and isincorporated herein by reference in its entirety. As described in the'009 patent, the spacer can be implanted and deployed to restore thespace between facets of a superior articular process of a first vertebraand an inferior articular process of an adjacent vertebra. As describedherein, the spacer can be implanted and deployed to help stabilizeadjacent vertebrae with adhesives, and/or can be implanted and deployedto deliver a medication. In such embodiments, the spacer can be, forexample, substantially disc shaped. In other embodiments, the spacer canbe other shapes, e.g., square, elliptical, or any other shape. Thespacer can include a first side and a second side. The first side and/orthe second side can be, for example, convex, concave, or flat. Saidanother way, the first side of the spacer can be concave, convex, orflat, and the second side of the spacer can be concave, convex, or flat,for example, the first side can be concave and the second side concave,the first side can be concave and the second side convex, etc. Thespacer can include the same materials as band 140. In some embodiments,the spacer can include substances configured to release medicationand/or increase the stability of a vertebra and/or band 140. Asdiscussed above, the substances can is include a medicine(s) and/or anadhesive(s).

FIGS. 8-10 show posterior perspective views of a portion of thevertebral column during a method for stabilizing adjacent vertebraeusing a flexible fastening band (“band”) 240 according to an embodiment.As shown in FIG. 8, a band 240 can be used to stabilize a vertebra V1and vertebra V2 via the inferior articular process IAP1A of vertebra V1and the superior articular process SAP2A of vertebra V2. Also as shownin FIG. 8, a flexible fastening band (“band”) 340 is used to stabilize avertebra V1 and vertebra V2 via the inferior articular process IAP1B ofvertebra V1 and the superior articular process SAP2B of vertebra V2. Insome embodiments, vertebra V1 and/or vertebra V2 are stabilized usingonly one of band 240 or band 340. In some such embodiments, one of band240 or band 340 can be used to stabilize vertebra V1 and/or vertebra V2via one of via the inferior articular process IAP1A of vertebra V1 andthe superior articular process SAP2A of vertebra V2, or, via theinferior articular process IAP1B of vertebra V1 and the superiorarticular process SAP2B of vertebra V2. In other such embodiments, oneof band 240 or band 340 can be used to stabilize vertebra V1 and/orvertebra V2 via both of the inferior articular process IAP1A of vertebraV1 and the superior articular process SAP2A of vertebra V2, and, theinferior articular process IAP1B of vertebra V1 and the superiorarticular process SAP2B of vertebra V2.

Each of band 240 and band 340 can be similar to band 140 described aboveand can include similar components. By way of example, band 240 includesa proximal end portion 242, a first portion 244, a second portion 246,and a distal end portion 248 including a fastening mechanism 250, andband 340 includes a proximal end portion (not shown in FIG. 8), a firstportion, a second portion, and a distal end portion including afastening mechanism. As shown in FIGS. 8-10, the shapes of first portion244, the first portion of band 340, second portion 246, and the secondportion of band 340 can all be cuboidal. As shown in FIG. 8, band 240includes a gear rack 247 and gears 264. Each of gears 264 can be wedgeshaped to allow each of gears 264 to displace the ratchet of fasteningmechanism 250 in only one direction. In some embodiments, gears 264 canbe other shapes, such as blocks, etc.

FIG. 11 depicts a flow chart illustrating a method 5000 of using band240 and/or band 340. Prior to use of band 240 and/or band 340, a patientcan be prepared for surgery, at 5002. Some examples of preparations forsurgery are described in the '009 patent. In addition to thoseprocedures described in the '009 application, in some embodiments, thesurgical procedure can include direct visualization of the vertebra(e)to be stabilized. Said another way, the medical practitioner can performthe operation without the use of fluoroscopy, and, in this manner, maynot have to rely on the inaccuracies and/or inconvenience inherent influoroscopic procedures. This direct visualization can be possible dueto the small incision necessary for implantation of the band, forexample, less than about 25 mm, and due to the ease of implanting anddeploying the band. In some embodiments, the surgical procedure used caninclude forming an opening in body tissue substantially equidistantbetween a first articular process of the first vertebra and a secondarticular process of the first vertebra. A tube (not shown) can beinserted through the opening and a proximal end of the tube can bepositioned near the lumen of superior articular process SAP2A ofvertebra V2. A drill or other device can be used to form a lumen insuperior articular process SAP2A of vertebra V2 and inferior articularprocess IAP1A of vertebra V1, at 5004. Specifically, the drill can beused to form the lumen in a facet of superior articular process SAP2A ofvertebra V2 and form the lumen in a facet of inferior articular processIAP1A of vertebra V1. Methods and devices for forming lumens in vertebraare described in the '009 application. The band 240 can be positionedwithin the tube and can be advanced through the tube until the proximalend portion 242 is positioned near the lumen of superior articularprocess SAP2A of vertebra V2. In some embodiments, the proximal end ofthe tube can have a bend to direct the proximal end portion 242 into thelumen of superior articular process SAP2A of vertebra V2. Proximal endportion 242 is inserted into the lumen of superior articular processSAP2A of vertebra V2 and through the lumen of inferior articular processIAP1A of vertebra V1, at 5006, and a portion of first portion 244 isadvanced through the lumen of superior articular process SAP2A ofvertebra V2 and through the lumen of inferior articular process IAP1A ofvertebra V1. The tube can be removed and/or reinserted at various pointsduring the method 5000, including, for example, after the proximal endportion of band 240 is inserted into the lumen formed within thesuperior articular process SAP2A of vertebra V2, after vertebra V1and/or Vertebra V2 has been stabilized, or at other points during method5000. In some embodiments, first portion 244 can be advanced through thelumen of superior articular process SAP2A of vertebra V2 and through thelumen of inferior articular process IAP1A of vertebra V1 such that onlysecond portion 246 is within the lumen of superior articular processSAP2A of vertebra V2 and through the lumen of inferior articular processIAP1A of vertebra V1. In this manner, when the shape of the secondportion is substantially similar to the shape of the lumen of thesuperior articular process of the first vertebra and shape of the lumenof the inferior articular process of second vertebra, the lumen can onlybe contacted by that portion of the band, for example, the secondportion, having the same shape.

As shown in FIG. 9, proximal end portion 242 is inserted into the lumenof fastening mechanism 250 of distal end portion 248, at 5008. In someembodiments, to insert proximal end portion 242 into fastening mechanism250 of distal end portion 248, a medical practitioner can grasp proximalend 242 and distal end 248, and manually insert proximal end portion 242into fastening mechanism 250. In other embodiments, one or both ofproximal end portion 242 and distal end portion 248 can be grasped withsurgical tools (not shown). In such embodiments, the surgical tools canbe configured to fit specific band configurations, for example, thesurgical tools can be configured to receive distal end 248 withoutobstructing the lumen of fastening mechanism 250. By way of anotherexample, the surgical tools can be configured to grasp and manipulateproximal end portion 242 and/or first portion 244. A portion of firstportion 244 is advanced through the lumen of fastening mechanism 250 ofdistal end portion 248 until superior articular process SAP2A ofvertebra V2 and inferior articular process IAP1A of vertebra V1 arestabilized, at 5010. In some embodiments, a surgical tool can be used toadvance first portion 244 through the lumen of fastening mechanism 250.In such embodiments, one portion of the surgical tool can be configuredto receive distal portion 248 without obstructing the lumen throughfastening mechanism 250, one portion of the surgical tool can beconfigured to grip and/or advance proximal end portion 242 and or firstportion 244. The surgical tool can be configured to restrict the amountof force and/or torque imparted on band 240 and/or to provide anindication to a medical practitioner of the amount of force and/ortorque imparted on the band. In some embodiments, the amount of forceand/or torque imparted on the band, and/or the amount of force and/ortorque used to provide and indication to the medical practitioner, canbe adjusted by the medical practitioner and/or can be determined by theconfiguration of the band selected for the procedure and/or by thephysiology of the patient. As each gear 264 of gear rack 247 passes overthe ratchet of fastening mechanism 250, the first portion 244 isprevented from retracting out of fastening mechanism 250. A portion offirst portion 244 is removed from band 240. In some embodiments, asurgical tool can be used to remove the portion of the band 240 thatextends beyond fastening mechanism 250. In such embodiments, thesurgical tool can be configured to maintain a grip on the portion of theband 240 that extends beyond the fastening mechanism 250 and is to beremoved. In this manner, the location of the removed portion of band 240can be controlled prior to, and after, removal. Band 340 can besubstantially similar to band 240 as shown in FIG. 10, and method 270can be used to implant and deploy band 340.

FIG. 12 depicts views of a flexible fastening band (“band”) 440, FIG. 13depicts a view of a portion of band 440, and FIG. 14 shows a portion ofthe vertebral column with adjacent vertebrae stabilized using band 440and a flexible fastening band (“band”) 540 according to an embodiment.As shown in FIG. 14, a band 440 can be used to stabilize a vertebra V3and vertebra V4 via the inferior articular process IAP3A of vertebra V3and the superior articular process SAP4A of vertebra V4. Also as shownin FIG. 14, a band 540 is used to stabilize a vertebra V3 and vertebraV4 via the inferior articular process IAP3B of vertebra V3 and thesuperior articular process SAP4B of vertebra V4. In some embodiments,vertebra V3 and/or vertebra V3 are stabilized using only one of band 440or band 540, as described above regarding band 240 and band 340.

Each of band 440 and band 540 can be similar to bands 140, 240, and 340described above and can include similar components. By way of example,band 440 includes a proximal end portion 442, a first portion 444, asecond portion 446, and a distal end portion 448 including a fasteningmechanism 450, and band 540 includes a proximal end portion (not shownin FIG. 14), a first portion 544, a second portion 546, and a distal endportion 548 including a fastening mechanism 550. In contrast to band 240and band 340, band 440 and band 540 each includes a cylindrical secondportion 446, 546, and each includes a third portion 449, 549,respectfully. As depicted in FIGS. 12-14, third portion 449 issubstantially the same shape as first portion 442, and as depicted inFIG. 14, third portion 549 is substantially the same shape as firstportion 542. As can be seen in FIG. 14, second portion 446 issubstantially the same diameter as the diameter of the lumen of superiorarticular process SAP4A of vertebra V4 and the diameter of the lumen ofinferior articular process IAP3A of vertebra V3, and second portion 546is substantially the same diameter as the diameter of the lumen ofsuperior articular process SAP4B of vertebra V4 and the diameter of thelumen of inferior articular process IAP3B of vertebra V3. When thediameter of the second portion is substantially the same as the lumen ofsuperior articular process SAP4B of vertebra V4 and the diameter of thelumen of inferior articular process IAP3B of vertebra V3, the amount ofopen space within the lumen can be minimized, the amount of surface areaof the second portion of the band in contact with the lumen canincrease, and subsequently the movement of vertebra V3 and/or vertebraV4 can be reduced or minimized. Furthermore, when movement of vertebraV3 and/or vertebra V4 does occur, forces acting against the band can bemore equally distributed throughout the second portion of the band, dueat least to the increased surface area of the band in contact with thelumen. As shown in FIGS. 12 and 13, band 440 includes a gear rack 447and gears 464. Each of gears 464 can be wedge shaped to allow each ofgears 464 to displace the ratchet of fastening mechanism 450 in only onedirection. In some embodiments, gears 464 can be other shapes, such asblocks, etc.

FIG. 15 depicts a perspective view of a spacer 654, and FIG. 16 depictsa portion of the vertebral column depicting a vertebra stabilized usinga flexible fastening band (“band”) 640 and spacer 654, and a flexiblefastening band (“band”) 740 and spacer 754 according to an embodiment.As shown in FIG. 16, a band 640 can be used to stabilize a vertebra V5and vertebra V6 via the inferior articular process IAP5A of vertebra V5and the superior articular process SAP6A of vertebra V5. Also as shownin FIG. 16, a band 740 is used to stabilize a vertebra V6 and vertebraV5 via the inferior articular process IAP5B of vertebra V5 and thesuperior articular process SAP6B of vertebra V6. In some embodiments,vertebra V5 and/or vertebra V6 are stabilized using only one of band 640or band 740, as described above regarding band 240 and band 340.

Each of band 640 and band 740 can be similar to bands 140, 240, 340,440, and 540 described above and can include similar components. Incontrast to bands 140, 240, 340, 440, and 540, band 640 can include aspacer 654, and band 740 can include a spacer 754. While not shown, anyof bands 140, 240, 340, 440, and 540, can include a spacer similar tospacer 654 and 754.

As shown in FIG. 15, spacer 654 can be substantially disc shaped. Spacer654 can be can be similar to, and have similar features to the spacerdescribed above and to the embodiments of the prosthesis shown anddescribed in the '009 application. Spacer 654 can be implanted anddeployed to restore the space between facets of a superior articularprocess of a first vertebra and an inferior articular process of anadjacent vertebra, can be implanted and deployed to help stabilizeadjacent vertebrae with adhesives, and/or can be implanted and deployedto deliver a medication. In such embodiments, the spacer can be, forexample, substantially disc shaped. In other embodiments, the spacer canbe other shapes, e.g., square, elliptical, or any other shape. Spacer654 include a first side 656 and a second side 658. As shown in FIG. 15,first side 656 is concave and second side 658 is convex. In someembodiments, first side 656 and/or the second side 658 can be convex,concave, or flat. Said another way, first side 656 of spacer 654 can beconcave, convex, or flat, and second side 658 of spacer 654 can beconcave, convex, or flat, e.g., first side 656 is concave and secondside 658 is concave, first side 656 concave and second side 658 isconvex, etc. In this manner, first side 656 and/or second side 658 canfit better against an articular process of a vertebra, specificallyagainst a facet of the articular process of the vertebra. Spacer 654 caninclude, for example, the same materials as band 640. In someembodiments, spacer 654 can include substances configured to releasemedication and/or increase the stability of a vertebra and/or band 640.As discussed above, the substances can is include a medicine(s) and/oran adhesive(s).

FIG. 17 depicts a flow chart illustrating a method 6000 of using band640 and/or band 740. Prior to use of band 640 and band 740, a patientcan be prepared for surgery, at 6002. Some examples of preparations forsurgery are described in the '009 application. In addition to thoseprocedures described in the '009 application, in some embodiments, thesurgical procedure can include direct visualization of the vertebra(e)to be stabilized. Said another way, the medical practitioner can performthe operation without the use of fluoroscopy, and, in this manner, maynot have to rely on the inaccuracies and/or inconvenience inherent influoroscopic procedures. This direct visualization can be possible dueto the small incision necessary for implantation of the band, forexample, less than about 25 mm, and due to the ease of implanting anddeploying the band. In some embodiments, the surgical procedure used caninclude forming an opening in body tissue substantially equidistantbetween a first articular process of the first vertebra and a secondarticular process of the first vertebra. A tube (not shown) can beinserted through the opening and a proximal end of the tube can beposition near the lumen of superior articular process SAP6A of vertebraV6. A drill or other device can be used to form a lumen in superiorarticular process SAP6A of vertebra V6 and inferior articular processIAP5A of vertebra V5, at 6004. Specifically, the drill can be used toform the lumen in a facet of superior articular process SAP6A ofvertebra V6 and to form the lumen in a facet of inferior articularprocess IAP5A of vertebra V5. Methods and devices for forming lumens invertebra are described in the '009 application. The band 640 can bepositioned within the tube and can be advanced through the tube untilthe proximal end portion is positioned near the lumen of superiorarticular process SAP6A of vertebra V6. In some embodiments, theproximal end of the tube can have a bend to direct the proximal endportion into the lumen of superior articular process SAP6A of vertebraV6. The proximal end portion is inserted into the lumen of superiorarticular process SAP6A of vertebra V6, at 6006. Spacer 654 is insertedbetween the superior articular process SAP6A of vertebra V6 and inferiorarticular process IAP5A of vertebra V5, at 6008. In some embodiments,spacer 654 can be disposed prior to inserting the proximal end portioninto the lumen of superior articular process SAP6A of vertebra V6. Thetube can be removed and/or reinserted at various points during themethod 6000, including, for example, after the proximal end portion ofband 640 is inserted into the lumen formed within the superior articularprocess SAP6A of vertebra V6, after vertebra V5 and/or Vertebra V6 hasbeen stabilized, or at other points during method 6000. In someembodiments, first portion 644 can be advanced through the lumen ofsuperior articular process SAP6A of vertebra V6 and through the lumen ofinferior articular process IAP5A of vertebra V5 such that only thesecond portion is within the lumen of superior articular process SAP6Aof vertebra V6 and through the lumen of inferior articular process IAP5Aof vertebra V5. In this manner, when the shape of the second portion issubstantially similar to the shape of the lumen of the superiorarticular process of the first vertebra and shape of the lumen of theinferior articular process of second vertebra, the lumen can only becontacted by that portion of the band, for example, the second portion,having the same shape.

The proximal end portion is inserted into the lumen of inferiorarticular process IAP5A of vertebra V5, at 6010. Proximal end portion642 is inserted into the lumen of fastening mechanism 650 of distal endportion 648, at 6012. In some embodiments, to insert the proximal endportion into fastening mechanism 650 of distal end portion 648, amedical practitioner can grasp the proximal end portion and distal end648, and manually insert the proximal end portion into fasteningmechanism 650. In other embodiments, one or both of the proximal endportion and distal end portion 648 can be grasped with surgical tools(not shown). In such embodiments, the surgical tools can be configuredto fit specific band configuration, for example, the surgical tools canbe configured to receive distal end 648 without obstructing the lumen offastening mechanism 650. By way of another example, the surgical toolscan be configured to grasp and manipulate the proximal end portionand/or first portion 644. A portion of first portion 644 is advancedthrough the lumen of superior articular process SAP6A of vertebra V6 andthrough the lumen of inferior articular process IAP5A of vertebra V5. Aportion of first portion 644 is advanced through the lumen of fasteningmechanism 650 of distal end portion 648 until superior articular processSAP6A of vertebra V6 and inferior articular process IAP5A of vertebra V5are stabilized, at 6014. In some embodiments, a surgical tool can beused to advance first portion 644 through the lumen of fasteningmechanism 650. In such embodiments, one portion of the surgical tool canbe configured to receive distal portion 648 without obstructing thelumen through fastening mechanism 650, one portion of the surgical toolcan be configured to grip and/or advance the proximal end portion and orfirst portion 644. The surgical tool can be configured to restrict theamount of force and/or torque imparted on band 640 and/or to provide anindication to a medical practitioner of the amount of force and/ortorque imparted on the band. In some embodiments, the amount of forceand/or torque imparted on the band, and/or the amount of force and/ortorque required to provide and indication to the medical practitioner,can be adjusted by the medical practitioner and/or can be determined bythe configuration of the band selected for the procedure and/or by thephysiology of the patient. As each gear of the gear rack passes over theratchet of the fastening mechanism, the first portion 644 is preventedfrom retracting out of the fastening mechanism. A portion of firstportion 644 is removed from band 640. In some embodiments, a surgicaltool can be used to remove the portion of the band 640 that extendsbeyond fastening mechanism 650. In such embodiments, the surgical toolcan be configured to maintain a grip on the portion of the band 640 thatextends beyond fastening mechanism 250 and is to be removed. In thismanner, the location of the removed portion of band 640 can becontrolled prior to, and after, removal. Band 740 and spacer 754 can besubstantially similar to band 640 and spacer 654, and method 770 can beused to implant and deploy band 740 and spacer 754.

FIG. 18 is a side view and FIG. 19 is a top view of a flexible fasteningband (“band”) 840 according to another embodiment. Band 840 can besimilar to band 140 and band 240 described above and can include similarcomponents. By way of example, band 840 includes a proximal end portion842, a first portion 844 including a gear rack 847, a second portion846, and a distal end portion 848 including a fastening mechanism 850and a ratchet 862. In contrast to gear rack 247, a cross sectional areaof each gear 864 of gear rack 847 is rectangular in shape instead ofwedge shaped. Furthermore, in contrast to first portion 244, firstportion 844 is cylindrical in shape instead of cuboidal in shape. Inthis manner, the lumen 866 of the fastening mechanism 850 is cylindricalin shape. A band according to this embodiment may be particularly usefulin deployments where a single band in used to stabilize adjacentvertebrae. In this manner, the second portion can be disposed within thelumen of the first articular process of the first vertebra and a portionof the first portion can be disposed within the lumen of the secondarticular process of the first vertebra. In these embodiments theportion of the band within the first articular process of the firstvertebra and the portion of the band within in the second articularprocess of the first vertebra can both have substantially the same shapeas the lumen in the first articular process of the first vertebra andthe lumen in the second articular process of the first vertebra. In thismanner, and as described above regarding band 440, the amount of openspace within the lumens can be minimized, the amount of surface area ofthe first portion and/or second portion of the band in contact with thelumens can increase, and subsequently the movement of the first vertebraand/or the second vertebra can be reduced or minimized. Furthermore,when movement of the first vertebra and/or the second vertebra doesoccur, forces acting against the band can be more equally distributedthroughout the first portion and/or the second portion, due at least tothe increased surface area of the band in contact with the lumens.

FIG. 20 is a side view a flexible fastening band (“band”) 940 accordingto an embodiment. Band 940 can be similar to band 140, band 240, andband 840 described above and can include similar components. By way ofexample, band 940 includes a proximal end portion 942, a first portion944 including a gear rack 947, a second portion 946, and a distal endportion 948 including a fastening mechanism 950. Similar to gear rack847, a cross sectional area of each gear 964 of gear rack 947 isrectangular in shape. In contrast to gear rack 847, each of gears 964extend the entire circumference of first portion 944 instead of only aportion of the circumference of first portion 844. Furthermore, incontrast to first portion 244, but similar to first portion 844, firstportion 944 is cylindrical in shape instead of cuboidal in shape. Inthis manner, the lumen 966 of the fastening mechanism 950 is cylindricalin shape. A band according to this embodiment may be particularly usefulin deployments where the movement and repositioning of the band afterimplantation may be difficult. In this manner, because each of the gearscan be the entire circumference of the first portion and/or the secondportion, the first portion and/or the second portion can enter thefastening mechanism in any radial orientation and still engage theratchet.

FIGS. 21-25 are views of a flexible fastening band (“band”) 1040according to another embodiment. FIG. 21 is a perspective view and FIG.22 is a cross-sectional side view of band 1040. FIG. 23 is across-sectional view of band 1040 taken along line XXIII. FIG. 24 is across-sectional top view of band 1040 in a first configuration and FIG.25 is a cross-sectional top view of band 1040 in a second configuration.Band 1040 can be similar to band 140 and band 240 described above andcan include similar components. By way of example, band 1040 includes aproximal end portion (not shown), a first portion 1044 including a gearrack 1047 (see FIG. 22), a second portion 106, and a distal end portion1048 including a fastening mechanism 1050 and a ratchet 1062. Incontrast to band 140 and band 240, band 1040 includes a reinforcementpiece 1072.

Reinforcement piece 1072 can include any of the materials describedabove for band 140. In some embodiments, reinforcement piece 1072 caninclude a material stronger than second portion 1046 and/or firstportion 1044, for example, first portion 1044 and second portion 1046can include PEEK and reinforcement piece 1072 can include titanium. Asshown in FIG. 22, reinforcement piece 1072 can be disposed within band1040 approximately along the entire length of second portion 1046, and aportion of reinforcement piece 1072 can be disposed within the distalend portion 1048. In some embodiments, reinforcement piece can include alength along at least a portion of the length of second portion 1046and/or first portion 1044 but not the distal end portion. In someembodiments, reinforcement piece 1072 can be disposed only within secondportion 1046. Reinforcement piece 1072 can have a length in firstdimension (length), a length in a second dimension (width), and a lengthin a third dimension (height). As described herein, a reinforcementpiece be different shapes that can include more or fewer dimensions.

The reinforcement piece can be molded within the band. Said another way,in embodiments where the first portion, the second portion, and or thedistal end portion are moldable materials, the reinforcement piece canbe placed in the mold and the moldable materials can be injected orotherwise put in the mold around the reinforcement piece. In otherembodiments, each portion of the band (for example, the proximal endportion, the first portion, the second portion, the third portion,and/or the distal end portion) around the reinforcement piece can have atop half and a bottom half, and each of the top half and the bottom halfcan be placed around the reinforcement piece, and sealed. As shown inFIG. 24, reinforcement piece 1072 includes support members 1074. WhileFIG. 24 shows reinforcement piece 1072 including four support members1074, in some embodiments, more or fewer support members 1074 can beused. Support members 1074 can maintain the position of reinforcementpiece 1072 during the molding and/or assembly process of band 1040. Asshown in FIG. 25, support members 1074 are removed before band 1040 isused.

As shown in FIG. 23, reinforcement piece 1072 can has a substantiallyuniform cuboidal shape. In other embodiments, reinforcement piece 1072can have other shapes. The shape of the reinforcement piece can beselected depending on the desired bending and/or torsion characteristicsof the material chosen. By way of example, a substantially planarcuboidal shape can provide a greater increase in bending strength whileproviding a lesser increase in torsion strength, a cylindrical shape canprovide an increase in bending strength while providing very littleincrease in torsion strength, a substantially square and/or tubularcuboidal shape can provide similar bending and torsion increases. Anyshape can be selected to achieve the desired bending and torsionstrength. Combinations of materials and shapes can also be considered.For example, a material having higher torsion strength may be combinedwith a shape having a lower torsion strength to combine for the desiredtorsion strength. As shown in FIGS. 24 and 25, reinforcement piece 1072includes holes 1076 distributed along the length of the first dimension.While FIGS. 24 and 25 shows band 1040 including many holes 1076, in someembodiments, more or fewer holes 1076 can be used. FIGS. 24 and 25depict holes 1076 distributed substantially equally along the length ofthe first dimension, in some embodiments, the holes can be distributeddifferently or along different dimensions depending on the shape and/ormaterial chosen, and/or whether the reinforcement piece is solid orhollow. Holes 1076 can be configured to reduce the weight ofreinforcement piece 1072 while still provided band 1040 additionalstrength. Holes 1076 can be round, oval, square, or any other shape.

FIG. 26 is an exploded view, FIG. 27 is a perspective view, and FIG. 28is a cross-sectional view of a flexible fastening band (“band”) 1140according to another embodiment. Band 1140 can be similar to band 140and band 240 described above and can include similar components. By wayof example, band 1140 includes a proximal end portion 1142, a firstportion 1144, a second portion 1146 including a gear rack 1147, a distalend portion 1148, a fastening mechanism 1150 and a ratchet 1162. Incontrast to band 140 and band 240, the fastening mechanism 1150 of band1140 is separately formed from band 1140. While second portion 1146 ofband 1140 is shown in FIGS. 26-28 as having a substantially cuboidalshape, in some embodiments, second portion 1146 can be substantiallycylindrical in shape or any other appropriate shape discussed herein. Asshown in FIGS. 27 and 28, band 1140 includes a gear rack 1147 and gears1164. Each of gears 1164 can be wedge shaped to allow each of gears 1164to displace a ratchet 1162 of fastening mechanism 1150 in only onedirection. In some embodiments, gears 1164 can be other shapes, such asblocks, or any other appropriate shape discussed herein. As shown inFIGS. 26-28, distal end portion 1148 can be substantially circular inshape and can have a diameter greater than a width of second portion1146. In other embodiments, distal portion 1148 can have other shapes,for example, oval, rectangular, square, etc.

FIG. 29 shows a posterior perspective view of a portion of the vertebralcolumn during a method for stabilizing adjacent vertebrae using band1140 and a flexible fastening band (“band”) 1240 according to anembodiment. Band 1240 can be similar to band 1140 described above andcan include similar components. By way of example, band 1240 includes aproximal end portion 1242, a first portion 1244, a second portion 1246,a distal end portion 1248, and a fastening mechanism 1250.

As shown in FIG. 29, a band 1140 can be used to stabilize a vertebra V11and a vertebra V12 via the inferior articular process IAP11A of vertebraV11 and the superior articular process SAP12A of vertebra V12. Also asshown in FIG. 29, band 1240 is used to stabilize a vertebra V11 andvertebra V12 via the inferior articular process IAP11B of vertebra V11and the superior articular process SAP12B of vertebra V12. In someembodiments, vertebra V11 and/or vertebra V12 are stabilized using onlyone of band 1140 or band 1240. In some such embodiments, one of band1140 or band 1240 can be used to stabilize vertebra V11 and/or vertebraV12 via one of via the inferior articular process IAP11A of vertebra V11and the superior articular process SAP12A of vertebra V12, or, via theinferior articular process IAP11B of vertebra V11 and the superiorarticular process SAP12B of vertebra V12.

Either of band 1140 and/or band 1240 can be used in accordance with anyof the methods described herein. By way of example, second portion 1146of band 1140 can be disposed in a lumen of IAP11A of vertebra V11 and ina lumen of SAP12A of vertebra V12. Proximal end portion 1142 is insertedinto a lumen of fastening mechanism 1150. In some embodiments, to insertproximal end portion 1142 into fastening mechanism 1150, a medicalpractitioner can grasp proximal end portion 1142 and fastening mechanism1150, and manually insert proximal end portion 1142 into fasteningmechanism 1150. In other embodiments, one or both of proximal endportion 1142 and fastening mechanism 1150 can be grasped with surgicaltools (not shown). In such embodiments, the surgical tools can beconfigured to fit specific band configuration, for example, the surgicaltools can be configured to receive fastening mechanism 1150 withoutobstructing the lumen of fastening mechanism 1150. A portion of firstportion 1144 is advanced through the lumen of fastening mechanism 1150until superior articular process SAP12A of vertebra V12 and inferiorarticular process IAP11A of vertebra V11 are stabilized.

FIG. 30 shows a posterior perspective view of a portion of the vertebralcolumn during a method for stabilizing adjacent vertebrae using aflexible fastening band (“band”) 1340 and a flexible fastening band(“band”) 1440 according to an embodiment. Each of band 1340 and band1440 can be similar to band 1140 described above and can include similarcomponents. By way of example, band 1340 includes a proximal end portion1342, a first portion 1344, a second portion (not shown in FIG. 30), adistal end portion 1348, and a fastening mechanism 1350; band 1440includes a proximal end portion 1442, a first portion 1444, a secondportion (not shown in FIG. 30), a distal end portion 1448, and afastening mechanism 1450. In contrast to band 1140 and band 1240, band1340 includes a spacer 1354, and band 1440 includes a spacer 1454. Eachof spacer 1354 and spacer 1454 can be similar to can be similar tospacer 654 described above and can include similar components.

As shown in FIG. 30, a band 1340 can be used to stabilize a vertebra V13and a vertebra V14 via the inferior articular process IAP13A of vertebraV13 and the superior articular process SAP14A of vertebra V14. Also asshown in FIG. 30, band 1440 is used to stabilize a vertebra V13 andvertebra V14 via the inferior articular process IAP13B of vertebra V13and the superior articular process SAP14B of vertebra V14. In someembodiments, vertebra V13 and/or vertebra V14 are stabilized using onlyone of band 1340 or band 1440. In some such embodiments, one of band1340 or band 1440 can be used to stabilize vertebra V13 and/or vertebraV14 via one of via the inferior articular process IAP13A of vertebra V13and the superior articular process SAP14A of vertebra V14, or, via theinferior articular process IAP13B of vertebra V13 and the superiorarticular process SAP14B of vertebra V14.

Either of band 1340 and/or band 1440 can be used in accordance with anyof the methods described herein. By way of example, the second portionof band 1340 can be disposed in a lumen of IAP13A of vertebra V13,spacer 1354 can be disposed between IAP13A and SAP14A, and the secondportion of band 1340 can be disposed in a lumen of SAP14A of vertebraV14. Proximal end portion 1342 is inserted into a lumen of fasteningmechanism 1350. In some embodiments, to insert proximal end portion 1342into fastening mechanism 1350, a medical practitioner can grasp proximalend portion 1342 and fastening mechanism 1350, and manually insertproximal end portion 1342 into fastening mechanism 1350. In otherembodiments, one or both of proximal end portion 1342 and fasteningmechanism 1350 can be grasped with surgical tools (not shown). In suchembodiments, the surgical tools can be configured to fit specific bandconfiguration, for example, the surgical tools can be configured toreceive fastening mechanism 1350 without obstructing the lumen offastening mechanism 1350. A portion of first portion 1344 is advancedthrough the lumen of fastening mechanism 1350 until superior articularprocess SAP14A of vertebra V14 and inferior articular process IAP13A ofvertebra V13 are stabilized.

While various embodiments have been described above, it should beunderstood that they have been presented by way of example only, notlimitation, and various changes in form and details may be made. Forexample, while the descriptions given are with reference to stabilizingvertebra, another bone(s), such as, for example, a sternum and/or arib(s) could be stabilized using the flexible fastening bands describedherein. In another example, a flexible fastening band can be used tostabilize and/or fixate an intramedullary (IM) rod or nail. For example,the flexible fastening band can be used at different longitudinallocations along an IM rod or nail, and used to couple adjacent boneportions to the IM rod or nail. In such situations, a given flexiblefastening band can fix a first bone portion, the IM rod or nail, and asecond bone portion, all of which are positioned between the distalportion and the proximal portion of the flexible fastening band. In yetanother example, a flexible fastening band can be used to stabilizeand/or fixate a bone fragment. While various embodiments have beendescribed above with regard to natural bone spaces, (e.g., the spacebetween an inferior articulate process and a superior articulateprocess), in other embodiments, the bone spacing can be man-made (e.g.,sternum split during a heart procedure), and/or due to an injury (e.g.,broken bone).

Where methods described above indicate certain events occurring incertain order, the ordering of certain events can be modified.Additionally, certain of the events can be performed concurrently in aparallel process when possible, as well as performed sequentially asdescribed above. Any portion of the apparatus and/or methods describedherein may be combined in any combination, except mutually exclusivecombinations. The embodiments described herein can include variouscombinations and/or sub-combinations of the functions, components and/orfeatures of the different embodiments described. For example, FIGS. 18and 19 depict band 840 including a single ratchet 862, and FIG. 20depicts band 940 including a single ratchet 962, however, in someembodiments, any of bands 140-1440 can include any number of ratchets.Similarly, any of bands 140-1440 can include a reinforcement pieceand/or a spacer.

1. An apparatus, comprising: an implant defining a first aperture andplurality of second apertures, the implant configured to receive atleast a portion of a fastener device in the first aperture of theimplant, the implant sized and configured to be disposed in contact witha first bone portion and a second bone portion such that the first boneportion and the second bone portion are fused after a portion of thefastener device is disposed within the first aperture of the implant andthe fastener device is secured relative to the first bone portion andthe second bone portion.
 2. The apparatus of claim 1, wherein: the firstbone portion is a superior articular process of a first vertebra, thesecond bone portion is an inferior articular process of a secondvertebra, the implant sized and configured to be disposed between afacet of the superior articular process of the first vertebra and afacet of the inferior articular process of the second vertebra.
 3. Theapparatus of claim 1, wherein: a central portion of the implant definesthe first aperture of the implant substantially about a center of theimplant, an outer portion of the implant defines the plurality of secondapertures of the implant between an outer edge of the implant and thefirst aperture of the implant and circumferentially about the firstaperture of the implant.
 4. The apparatus of claim 1, wherein theimplant includes a substance configured to increase stability of thefirst bone portion and the second bone portion when the implant isdisposed in contact with the first bone portion and the second boneportion and when the fastener device is secured relative to the firstbone portion and the second bone portion.
 5. The apparatus of claim 1,wherein: the implant has a first side and a second side opposite thefirst side, the first side of the implant is concave, the second side ofthe implant is convex.
 6. The apparatus of claim 1, wherein: the implanthas a first side and a second side opposite the first side, the secondside of the implant is convex, the first side of the implant is concavesuch that the first side of the implant substantially conforms to anouter surface of the first bone portion when a portion of the fastenerdevice is disposed within the first aperture of the implant and thefastener device is secured relative to the first bone portion and thesecond bone portion.
 7. The apparatus of claim 1, wherein: the implanthas a first side and a second side opposite the first side, the implantbeing formed of a compliant material, the first side of the implantsubstantially conforms to an outer surface of the first bone portion andthe second side of the implant substantially conforms to an outersurface of the second bone portion when the portion of the fastenerdevice is disposed within the first aperture of the implant and thefastener device is secured relative to the first bone portion and thesecond bone portion.
 8. The apparatus of claim 1, wherein: the firstbone portion is a superior articular process of a first vertebra, thesecond bone portion is an inferior articular process of a secondvertebra, the implant has a first side and a second side opposite thefirst side, the implant being formed of a compliant material, the firstside of the implant substantially conforms to an outer surface of thesuperior articular process and the second side of the implantsubstantially conforms to an outer surface of the inferior articularprocess when the portion of the fastener device is disposed within thefirst aperture of the implant and the fastener device is securedrelative to the first bone portion and the second bone portion.
 9. Amethod, comprising: disposing an implant in contact with the first boneportion and the second bone portion, the implant defining a firstaperture and a plurality of second apertures; and advancing a portion ofa fastener device through a lumen of the first bone portion, the firstaperture of the implant and a lumen of the second bone portion; andsecuring the fastener device to the first bone portion and the secondbone portion such that the first bone portion and the second boneportion are stabilized for a duration sufficient for the first boneportion and the second bone portion to be fused.
 10. The method of claim9, wherein the implant includes a substance configured to increasestability of the first bone portion and the second bone portion.
 11. Themethod of claim 9, further comprising: forming the lumen in a first boneportion; forming the lumen in a second bone portion; and substantiallyaligning the lumen of a first bone portion, the first aperture of theimplant, and the lumen of the second bone portion.
 12. The method ofclaim 9, wherein: the first bone portion is a superior articular processof a first vertebra, the second bone portion is an inferior articularprocess of a second vertebra, the implant sized and configured to bedisposed in contact with a facet of the superior articular process ofthe first vertebra and a facet of the inferior articular process of thesecond vertebra.
 13. The method of claim 9, wherein: a central portionof the implant defines the first aperture of the implant substantiallyabout a center of the implant, an outer portion of the implant definesthe plurality of second apertures of the implant between an outer edgeof the implant and the first aperture of the implant andcircumferentially about the first aperture of the implant.
 14. Themethod of claim 9, wherein: the implant has a first side and a secondside opposite the first side, the second side of the implant is convex,the first side of the implant is concave, the disposing includingdisposing the implant in contact with the first bone portion and thesecond bone portion such that the first side of the implantsubstantially conforms to an outer surface of the first bone portion.15. The method of claim 9, wherein: the implant has a first side and asecond side opposite the first side, the second side of the implant isconvex, the first side of the implant is concave, the disposingincluding disposing the implant in contact with the first bone portionand the second bone portion such that the first side of the implantsubstantially conforms to an outer surface of the first bone portion andthe second side of the implant substantially conforms to an outersurface of the second bone portion.
 16. The method of claim 9, wherein:the first bone portion is a superior articular process of a firstvertebra, the second bone portion is an inferior articular process of asecond vertebra, the implant has a first side and a second side oppositethe first side, the implant being formed of a compliant material, thedisposing including disposing the implant in contact with the first boneportion and the second bone portion such that the first side of theimplant substantially conforms to an outer surface of the superiorarticular process and the second side of the implant substantiallyconforms to an outer surface of the inferior articular process.
 17. Anapparatus, comprising: an implant defining a first aperture andplurality of second apertures, the implant configured to receive atleast a portion of a fastener device in the first aperture of theimplant, the implant configured to receive at least a portion of afastener device in the first aperture of the implant such that a firstbone portion and a second bone portion are stabilized for a durationsufficient for the first bone portion and the second bone portion to befused, the implant configured to receive a substance that increasesstability of the first bone portion and the second portion.
 18. Theapparatus of claim 17, wherein: the first bone portion is a superiorarticular process of a first vertebra, the second bone portion is aninferior articular process of a second vertebra, the implant sized andconfigured to be disposed between a facet of the superior articularprocess of the first vertebra and a facet of the inferior articularprocess of the second vertebra.
 19. The apparatus of claim 17, wherein:a central portion of the implant defines the first aperture of theimplant substantially about a center of the implant, an outer portion ofthe implant defines the plurality of second apertures of the implantbetween an outer edge of the implant and the first aperture of theimplant and circumferentially about the first aperture of the implant.20. The apparatus of claim 17, wherein: the implant has a first side anda second side opposite the first side, the second side of the implant isconvex, the first side of the implant is concave such that the firstside of the implant substantially conforms to an outer surface of thefirst bone portion when a portion of the fastener device is disposedwithin the first aperture of the implant and the fastener device issecured relative to the first bone portion and the second bone portion.